Thursday, November 01, 2012

The moral limits of incentives?

My sincere belief that all organisations funded by force are immoral - and that we must therefore not be surprised when people within them behave in immoral ways (and organise cover-ups to protect each other) - was further strengthened when I read my Daily Telegraph this morning. The Government is apparently giving financial incentives to NHS trusts to adopt the controversial Liverpool Care Pathway;

Almost two thirds of NHS trusts using the Liverpool Care Pathway have received payouts totalling millions of pounds for hitting targets related to its use, research for The Daily Telegraph shows.

On the face of it, the results would impress even the hardest-line "rational actor" economist and shock all our leftist friends who believe humans are not motivated in such crude ways;

Central Manchester University Hospitals - which received £81,000 in 2010 for meeting targets relating to the LCP - said the proportion of patients whose deaths were expected and had been placed on the pathway more than doubled to 87.7 per cent in the past year.

The reaction from Dr Phillip Lee, the Tory MP for Bracknell and a former GP, in defending the NHS is that;

I just cannot believe that there is anybody in the palliative care arena who is trying to anything other than provide the best care for patients.”

I would like to believe that too, doctor, but if it's true that 87.7% of such patients in Manchester needed this form of care this year, surely it was true last year too? if it was true last year, why did those noble people in palliative care not act to relieve so much suffering? Why did they wait until incentives were applied?

I do not oppose the LCP itself. My late wife was put on it when she was dying of cancer last year - though I insisted she be hydrated throughout and was promised she would be fed if she wanted. Fortunately for my conscience in the wake of all these stories, she died within hours of my giving consent and so did not have time to starve to death.

I am merely concerned - as I think any humane person should be - about allegations that it is being misused and suspicions that - rather than being used solely in the interests of dying patients, it is sometimes deployed for the convenience of the NHS management and staff. The fact that they are being incentivised - and that incentives are having such radical statistical effects - makes me more worried. Is that unreasonable?

Comments

My sincere belief that all organisations funded by force are immoral - and that we must therefore not be surprised when people within them behave in immoral ways (and organise cover-ups to protect each other) - was further strengthened when I read my Daily Telegraph this morning. The Government is apparently giving financial incentives to NHS trusts to adopt the controversial Liverpool Care Pathway;

Almost two thirds of NHS trusts using the Liverpool Care Pathway have received payouts totalling millions of pounds for hitting targets related to its use, research for The Daily Telegraph shows.

On the face of it, the results would impress even the hardest-line "rational actor" economist and shock all our leftist friends who believe humans are not motivated in such crude ways;

Central Manchester University Hospitals - which received £81,000 in 2010 for meeting targets relating to the LCP - said the proportion of patients whose deaths were expected and had been placed on the pathway more than doubled to 87.7 per cent in the past year.

The reaction from Dr Phillip Lee, the Tory MP for Bracknell and a former GP, in defending the NHS is that;

I just cannot believe that there is anybody in the palliative care arena who is trying to anything other than provide the best care for patients.”

I would like to believe that too, doctor, but if it's true that 87.7% of such patients in Manchester needed this form of care this year, surely it was true last year too? if it was true last year, why did those noble people in palliative care not act to relieve so much suffering? Why did they wait until incentives were applied?

I do not oppose the LCP itself. My late wife was put on it when she was dying of cancer last year - though I insisted she be hydrated throughout and was promised she would be fed if she wanted. Fortunately for my conscience in the wake of all these stories, she died within hours of my giving consent and so did not have time to starve to death.

I am merely concerned - as I think any humane person should be - about allegations that it is being misused and suspicions that - rather than being used solely in the interests of dying patients, it is sometimes deployed for the convenience of the NHS management and staff. The fact that they are being incentivised - and that incentives are having such radical statistical effects - makes me more worried. Is that unreasonable?